Provider Demographics
NPI:1386824878
Name:RICHARD C WEIERMILLER JR M D PLLC
Entity Type:Organization
Organization Name:RICHARD C WEIERMILLER JR M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WEIERMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-795-1390
Mailing Address - Street 1:2311 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4812
Mailing Address - Country:US
Mailing Address - Phone:586-795-1390
Mailing Address - Fax:586-795-1395
Practice Address - Street 1:2311 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4812
Practice Address - Country:US
Practice Address - Phone:586-795-1390
Practice Address - Fax:586-795-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRW071822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3517199Medicaid
MIG80793Medicare UPIN